Those were the contrasting visions depicted today by prosecutors and defense lawyers in a health care fraud case that got under way in federal court.

Assistant U.S. Attorney Greg Bordenkircher told jurors in his opening statement that greed motivated the 6 defendants, who cheated taxpayers to get rich off the sale of medication used to treat hemophilia patients. Attorneys for the defense countered that the case is about blood — the missing clotting agents that put patients at the mercy of incredibly expensive protein replacement medication known as Factor — and the defendants’ concern for those patients.

The case revolves around a pair of specialty pharmacies, MedfusionRx in Birmingham, and the now-defunct Hemophilia Infusion Managers in Loxley. The owners of both businesses stand accused of paying people to refer customers needing Factor.

The law and the contracts that the businesses signed with the Alabama Medicaid Agency make it clear that pharmacies cannot pay such commissions except to bona fide employees, Bordenkircher said. So, he told jurors, the pharmacies evaded those requirements.

“They created sham jobs — ghost jobs,” he said. “The only things they (the people who received commissions) had were the lists of patients.”

Waters was of people given a phony job, Bordenkircher said. He said Medfusion gave him 50 percent of the net profits from the sale of factor. He said Waters became a millionaire between 2007 and 2009. What’s more, Bordenkircher added, the company gave him a personal automated teller machine card paid for by Medfusion and bought him a car and a house.

All the while, Bordenkircher said, Waters spent no time in the office, filed no reports and did no work other than hand over a list of hemophilia patients.

“He was hardly at the job because there was hardly a job to be at,” he said.

Bordenkircher said Medfusion and HIM made similar deals with Lori Skowronski Brill, who also referred patients. She made $600,000 in referral fees, he said.

Attorneys for the defendants denied any wrongdoing.

“This case is about blood,” said Jackson Sharman III, an attorney for Chris Vernon, who owned Medfusion with his brother before they sold it. “The government wants you to think it’s about money. But it’s about blood.”

James Sturdivant, an attorney for Jeff Vernon, said all of the company’s records and dealings were transparent and above-board. He pointed out that the price Mefusion paid for the Factor medication was set by the manufactures and the price the pharmacy charged was set by Medicaid.

“There will be absolutely no evidence that the taxpayers or private insurance paid any more for medications that was appropriate,” Sturdivant said. “Every medication was based on a real prescription written by a real physician for the care of a real patient with a real and serious medical condition."

Sturdivant and other attorneys said that Waters and Brill were genuine employees who were issued IRS tax forms. Sturdivant said Medfusion paid them in commissions on sales, the same way that sales associates in many industries all over the country earn their money.

Gordon Armstrong, an attorney for HIM co-owner Tony Eric Mosley, said Brill worked for his client for about a year. He told jurors that when HIM fired her, she applied for — and received — unemployment benefits from the state.

“You don’t get that if you’re not an employee,” he said.

Armstrong said prosecutors have been mistaken about his client, including even getting his name wrong on the indictment. “They’ve had him pegged wrong from the very beginning of the case,” he said.

Sturdivant said the defense would not shy from the success enjoyed by Medfusion. It grew from $12 million in sales in 2005 to more than $200 million in 2010. But Sharman said only about 10 percent of that total came from Factor sales, and only 30 of the pharmacy’s 14,000 patients were hemophilia patients.

Bordenkircher, though, said the defendants gamed the system. He HIM had only 8 customers other than the children of the pharmacy’s owners. Brill also took advantage of a hemophiliac son, he said.

“They used Medicare and Medicaid as personal ATM machines to enrich themselves off the backs of sick kids,” he said.

Brill’s lawyer, Peter Madden, said his client made hemophilia her life’s work because she has a brother and a son who suffer from the incurable disease. That led her to start a patient advocacy business and a pair of second-hand stores that hired hemophiliacs, he said.

“What motivates Lori Birll? What was her intent?” Madden asked. “What motivates Lori Brill is that she was born into those hemophilia community.”